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The 2020-2021 influenza season in the United States was historically quiet since so many people took steps to mitigate COVID-19 exposure (e.g., masking, hand washing, travel restrictions, and school closures). As a result, reduced population immunity could make this flu season more severe. Nationwide, both laboratory-confirmed influenza detection and outpatient visits for influenza-like illness have increased in the last weeks of 2021.

Partnering with Birthing Hospitals to Protect Babies Against RSV Partnering to Protect Babies Against RSV Susan Kansagra, Michelle Fiscus, Kim Martin Learn how immunization programs partnered with birthing hospitals to expand participation in Vaccines for Children and better protect babies against RSV. In 2023, the Advisory Committee on Immunization Practices (ACIP) recommended the use of monoclonal antibodies (mAbs) to prevent respiratory syncytial virus (RSV) in infants, a major milestone in newborn immunization. Unlike vaccines, which stimulate the body’s immune system to produce its own protection over time, mAbs work right away by giving the body ready-made protection against infection. This is especially important for newborns who do not have the protection of maternal RSV vaccination, which causes them to face a higher risk of severe RSV illness and need protection as early as possible. In response to the 2023 ACIP recommendation, state and territorial immunization programs acted quickly to ensure these new protections reached the babies who needed them most. One of the most effective strategies was partnering with birthing hospitals to expand participation in the Vaccines for Children (VFC) program, a federally funded initiative that provides vaccines to children at no cost to their families who might otherwise be unable to afford them. This program enabled the delivery of RSV mAbs — such as nirsevimab and now clesrovimab — to VFC-eligible newborns without any financial burden on their families. High Stakes, Strong Results The stakes were high, as RSV is the leading cause of infant hospitalizations in the United States. It was previously responsible for an estimated 58,000 to 80,000 hospitalizations and up to 300 deaths in children under age five each year. Data on RSV mAbs showed significant results, reducing RSV-related emergency department visits by 63% and hospitalizations by as much as 80%. Administering RSV mAbs in the first few days after birth, during RSV season, ensures that infants are protected before their first exposure — a critical step in reducing illness and health care burden. Strategies for Success Health departments played a leading role in bringing birthing hospitals into the VFC program. Many hospitals were not previously enrolled, often due to limited awareness, logistical barriers, or concerns about administrative burdens. Immunization programs responded by 1) launching targeted outreach, 2) offering tailored technical assistance, 3) simplifying enrollment processes, and 4) providing guidance on proper storage, eligibility screening, and documentation. The Impact of Stronger Partnerships These efforts have generated measurable results: The number of birthing hospitals enrolled in the VFC program increased from 292 in the 2023 season to 1,012 in 2025, boosting coverage from 10% to 36% of all U.S. birthing hospitals. This clearly demonstrates that these partnerships are effective and make a real difference in protecting infants’ health. State data further highlights this success and shows that collaboration across states, hospitals, and public health partners is crucial for achieving measurable impact: Virginia nearly doubled the number of birthing hospitals enrolled in the VFC program, increasing from six to 11 within one year. The state’s immunization program implemented an innovative Replacement Model to simplify requirements and collaborate closely with hospital teams to overcome barriers. Similarly, California provided resources, developed an enrollment checklist, and communicated the benefits of enrollment to birthing hospitals. Finally, across six states, 33 hospitals, and 400 clinics over two RSV seasons, Intermountain Health coordinated a system-wide approach that developed educational tools, enrolled hospitals in VFC, and addressed supply shortages. It also piloted a Replacement Model where mAb product was purchased by the hospital and doses administered to VFC-eligible babies were replaced with VFC-funded stock. These efforts also strengthened relationships between public health programs and birthing institutions. Trust and communication improved, and hospitals became more engaged in broader immunization goals (e.g., access to other birth-dose vaccines like hepatitis B). This expanded partnership not only protected newborns during RSV season but reinforced the capacity of immunization programs to mobilize quickly, implement new recommendations, and ultimately improve health outcomes. Compared to prior seasons, RSV-associated hospitalization rates were 28%-43% lower in 2024-2025, which was the first season with widespread availability of mAbs and maternal RSV vaccine. Future Opportunities Health departments have used a number of strategies to increase VFC enrollment by hospitals and mAbs coverage as a whole, including: Using birth volume data to prioritize outreach to additional hospitals for enrollment in the VFC program. Ensuring linkage to Immunization Information Systems to determine maternal RSV vaccination status and quickly identify eligible infants. Working with health systems on standing orders and protocols to help providers administer mAbs rapidly to eligible infants. Bringing hospitals and payers together to provide financial models that support universal coverage. While bundled payments for labor and delivery stays have been a barrier for private payer coverage, the high ROI for preventing future RSV-related health care utilization may provide additional opportunities for payers to consider alternative coverage models. Sharing promising practices through a Learning Collaborative webinar series developed by the Association of Immunization Managers, in coordination with CDC. The rapid rollout of RSV mAbs through the VFC program is a model of success. It shows that when public health agencies and health care partners work together, we can deliver lifesaving interventions, even in complex, high-volume settings like birthing hospitals. As new immunization tools emerge in the years ahead, the infrastructure, lessons and relationships built through this effort will continue to support the goal of protecting all children from the very start. article yes

Policies that broadly define "vaccine" expand access to life saving immunization products.

Understanding Current U.S. Measles Outbreaks and Elimination Status Current U.S. Measles Outbreaks and Elimination Status Jessica Baggett, Susan Kansagra, Meredith Allen, Kimberly Martin Understand current U.S. measles outbreaks and the country's elimination status, following recent outbreaks and the highest case counts in decades. In 2016, the Pan American Health Organization (PAHO) declared the elimination of measles in the Region of the Americas, marking a monumental public health achievement. But in 2025, that progress came under threat and remains at risk at the top of 2026 — as recent measles outbreaks have driven the highest case counts in decades, prompting health agencies to reassess elimination status. Current Outbreaks Jan. 21 marks one year since the first U.S. measles outbreak of 2025 was reported. The United States went on to experience its worst year for measles in over three decades, with 2,144 confirmed cases. According to CDC, there were 49 outbreaks in 2025 and 88% of confirmed cases (1,884 of 2,144) were outbreak-associated. For comparison, 16 outbreaks were reported during 2024 and 69% of cases (198 of 285) were outbreak-associated. Most 2025 cases occurred in unvaccinated (93%) or under-vaccinated (3%) individuals, and three deaths were confirmed. Measles Elimination These outbreaks put the United States at risk of losing elimination status if transmission of the same strain continues for 12 months uninterrupted. In public health terms, “elimination” means that a disease’s continuous (endemic) spread within a region has ceased for at least 12 months. While it doesn’t necessarily mean zero cases, it does mean that local chains of transmission have been interrupted. The United States achieved elimination status in 2000 due to high coverage with the measles, mumps, and rubella (MMR) vaccine, strong disease surveillance, and public health response to isolated cases. Other countries in the Americas followed similar paths. As a result, PAHO verified the region as measles-free for years. Why Elimination Status Matters Elimination is more than a label. It reflects protective immunity within a population and the capacity of the public health system to prevent sustained outbreaks. When elimination status holds: Transmission is less likely, preventing widespread illness and death. Health care systems avoid unnecessary strain from preventable care utilization. Public health systems circumvent the toll of managing large outbreaks. Vulnerable groups (i.e., infants too young for vaccination, immunocompromised people) are better protected. Public confidence in immunization programs remains strong. What Happens if Elimination Is Lost? In November 2025, PAHO announced that the Region of the Americas — including the United States and Canada — lost measles elimination status after endemic transmission persisted, especially in Canada, for more than 12 months. This means that measles is once again circulating continuously within the region rather than only in isolated imported cases and quickly contained outbreaks. CDC is currently working with state and local health officials to analyze data and determine individual U.S. status, assessing if the various outbreaks are linked, which would signify ongoing transmission rather than individual introductions of disease. In November 2025, Canada officially declared their lost elimination status following prolonged transmission in 2024-2025. Ongoing outbreaks in Mexico and other parts of the Americas further contributed to the rise in regional case counts. Finally, PAHO invited both the United States and Mexico to a virtual meeting on April 13 to review their current measles elimination status. Endemic transmission makes outbreaks larger and more frequent, and increases the number of people who become ill, particularly those not protected by vaccination. Ongoing measles transmission also requires additional public health resources including expanded surveillance, outbreak response, and efforts to raise vaccination coverage, especially in communities with low immunization rates. This adds strain to health departments which often have fixed resources, with one study estimating the average cost per measles case at nearly $60k when including the public health perspective. Measles transmission in the United States has disproportionately impacted communities with lower vaccination rates. Therefore, the loss of elimination status could necessitate greater attention to vaccination recommendations for international travelers coming to the United States, particularly for infants. For example, similar to U.S. recommendations for those traveling internationally, Australia suggests that infants 6-11 months traveling to areas where measles is endemic or having an outbreak can get assessed for an earlier dose of the measles vaccine. Response Strategies for Public Health Departments While the United States works to determine its official status, there are many activities state and territorial public health departments continue to implement to prevent the spread of measles: Vaccination Campaigns The MMR vaccine is highly effective in preventing measles, with CDC reporting 93% protection after one dose and 97% after two doses. Herd immunity is a critical preventive measure that interrupts transmission and requires approximately 95% of the population to be vaccinated. Despite this strong science, falling vaccination rates driven by hesitancy, misinformation, and gaps in access have left pockets of the population vulnerable. Boosting vaccination is the most effective way to stop outbreaks, protect children and adults (particularly those who can’t get vaccinated), and prevent hospitalizations and deaths. Examples of vaccination campaigns include New York’s “Immunization Is Protection” and Minnesota’s reminders about immunization importance. Analyzing Local Data to Identify High Risk Sub-Populations Public health departments are evaluating local Immunization Information System data to identify sub-populations with lower measles vaccination rates, areas with high exemption rates, and settings with persistent under-immunization. Examples include Illinois’ Vaccination Coverage Dashboards, Washington’s Immunization Measures by County Dashboard, and American Immunization Registry Association’s Small Area Analysis. Understanding which populations are at higher risk can inform education and outreach activities. Establishing Relationships with Trusted Community Messengers Identifying under-vaccinated sub-populations is only beneficial when health departments build trust and authentic engagement within communities. They must work with trusted messengers such as faith leaders, community health workers, and local organizations to co-develop and amplify messages about measles risks and the importance of MMR vaccination. In addition, it is important to tailor communication materials to reflect community languages, values, and concerns. Communities are more likely to accept and act on respectful, relevant messaging. Examples of successful community partnerships include the Palmetto Community Action Partnership, the Enrichment Services Program, and the Community Action Program for Central Arkansas. Read ASTHO’s “Championing Change” Toolkit for more information and examples. Supporting Health Care Systems and Providers Clinicians remain highly trusted voices within communities. Health departments equip providers with up-to-date information and resources to ensure they are prepared to recognize, test, report, and manage measles cases effectively. Examples of these resources include CDC’s Be Ready for Measles Toolkit, Arizona’s Measles Surveillance Toolkit, South Carolina’s Measles Clinical Assessment Guide, and North Carolina’s Measles (Rubeola) Resources for Health Care Providers. article yes

Immunization Information Systems: One Foundational Data Source, Endless Health Insights Immunization Information Systems - Endless Health Insights Kim Martin, Mary Beth Kurilo Learn how public health agencies can better share critical data across jurisdictions in this blog post. A Bold Vision Back in 2014, a state health official from the Midwest recognized a problem: immunization information systems (IIS) were jurisdictionally based — mostly at the state level — resulting in data gaps when people moved or received care across state lines. In talking with his ASTHO colleagues, he shared a bold vision: what if ASTHO led a coordinated effort to unite key stakeholders and make widespread, seamless interjurisdictional immunization data exchange a reality? Momentum built quickly, and by the end of the year, ASTHO had convened a broad coalition of stakeholders and meaningful progress followed: A draft memorandum of understanding (MOU) to enable data exchange across jurisdictions. A community of practice that fostered peer-to-peer learning and problem-solving. Stronger support for the development and implementation of the Immunization (IZ) Gateway, a federally sponsored technology solution and infrastructure that facilitates immunization data exchange. As these efforts advanced, organizations like the American Immunization Registry Association (AIRA), a national nonprofit dedicated to supporting and strengthening IIS, played a growing role in supporting IIS interstate data exchange while continuing to advance data standards, improve data quality, and promote IIS modernization across the country. Results: Connections Continue to Expand Today, 57 IIS jurisdictions have signed interjurisdictional exchange MOUs, and 44 jurisdictions are participating in IIS-to-IIS data exchange through the IZ Gateway. Those 44 jurisdictions have connections with their peer IISs for a total of 361 live connections that create pathways for data to securely flow across state lines. Have we completely solved the interjurisdictional data challenge? Not entirely, but we are well on our way to a collaborative solution that addresses a significant proportion of the data gap. As this state health official pointed out, broad collaboration is not only essential to this work — it’s a defining strength of ASTHO, AIRA, and the wider immunization community. Unprecedented Times We often hear that we are operating in unpredictable and evolving times. During recent discussions, immunization program staff highlighted potential risks to immunization infrastructure, particularly IIS, due to cuts in federal funding. With funding winding down, jurisdictions are anticipating impacts such as staffing reductions, the loss of contracted support, and the slowing or halting of ongoing data modernization work. These systems are important not just for supporting routine immunization efforts, but also for readiness in future outbreak or emergency responses. As the funding landscape continues to evolve, it's important to highlight the central role IIS play in providing timely, high-quality data to a wide range of stakeholders, including: State, tribal, local, and territorial health departments, which use IIS data to monitor coverage rates, manage vaccine ordering and inventory, and support reminder/recall efforts. Health care providers, who access IIS through bidirectional connections with Electronic Health Records or pharmacy systems to deliver informed care at the point of service. Long-term care and skilled nursing facilities, which serve vulnerable populations and depend on complete immunization histories for residents. Educational institutions — including colleges, secondary schools, and childcare centers — that verify student immunization status during enrollment. Health payers, who enhance claims data with IIS records to improve Healthcare Effectiveness Data and Information Set reporting and member outreach. Federal partners, who use IIS data to support nationwide surveillance and response efforts. Individuals and families who are increasingly empowered to access their own immunization records for health care, school, travel, and personal use. Immunization data is undeniably a vital resource that supports and strengthens both public and private health systems, helping keep communities healthy and ensuring we are better prepared for the next outbreak or pandemic. Where Do We Go Next? Broad interjurisdictional exchange of immunization data started with a vision from a single state health official. What can we tackle together next? Advocate for sustained IIS funding through public/private partnerships — We need to consider new funding models for IIS. With so many partners valuing and benefiting from IIS data, we have a rich resource to protect and support together. We could look to key partners (CMS and private payers, large health systems, EHR vendors, pharmacies) to support the systems and programs that ensure the secure exchange of immunization data. Support ubiquitous consumer access — All individuals can benefit from convenient and efficient access to their own and their family members’ immunization records to manage their health, inform their health care decisions, or supply documentation for work, travel, or school/childcare requirements. Today, only about half of the United States has direct consumer access to their immunization record in the IIS. Encourage broad IIS participation — We can all actively promote policies or incentives that encourage authorized health care providers and partners to exchange data with their IIS. However, not everything needs to be a formal law or policy. Sometimes, simply fostering a culture of routine reporting to or querying the IIS as the standard of care can make a meaningful difference. It’s also important to ensure onboarding processes are efficient and that providers and partners receive the necessary technical support. Ensure legal and policy support for your IIS — Advocate for laws and regulations that support provider reporting, data sharing, and patient access while safeguarding privacy. Address barriers such as consent requirements that may add burden to providers and limit comprehensive data collection. Together, we can ensure that IIS are robust, reliable, and an integral part of immunization programs and the broader public health infrastructure. By strengthening these systems, we help ensure individuals receive high-quality, personalized care — wherever they are. article yes

Outcomes and Implications of ACIP’s Vote on the Hepatitis B Vaccine for Newborns Implications of ACIP Vote on Hepatitis B Vaccine for Newborns Susan Kansagra, Andy Baker-White, Kim Martin, Jessica Baggett Learn about the outcomes and implications of the December 2025 ACIP vote on the hepatitis B vaccine for newborns. On Dec. 4 and 5, the Advisory Committee on Immunization Practices (ACIP) held a long-anticipated meeting featuring two major topics of discussion: the hepatitis B birth dose and the pediatric vaccine schedule. The committee voted on two questions related to the pediatric hepatitis B vaccine schedule, both of which passed. To briefly summarize the outcome of the meeting, ACIP shifted from recommending a universal birth dose of the hepatitis B vaccine for all newborns to individualized decision-making for newborns born to HBsAg-negative mothers. There was no change to the recommendation for infants born to HBsAg-positive mothers or whose HBsAg status is unknown. CDC has not yet adopted these changes. In the meantime, many states are taking actions to provide clarity to providers and promote public confidence in the vaccine. How States Are Taking Action In response to (and in some cases before) the new ACIP recommendations, several states issued recommendations, guidelines, standing orders, executive directives, and health alerts for providers to provide clarity. States Recommending or Encouraging the Full Vaccine Series Some states are issuing their own guidance and recommendations for the hepatitis B vaccine series or encouraging providers to adhere to the series as is it was before the new ACIP recommendations: The Northeast Public Health Collaborative released a consensus statement before the ACIP meeting recommending the hepatitis B vaccine birth dose and a schedule that aligns with clinical recommendations. Collaborative members also issued statements reaffirming their adherence to established hepatitis B vaccine recommendations, including Connecticut, Maine, Maryland, Massachusetts, New Jersey, New York, Pennsylvania, and Rhode Island. Maryland also released guidance for parents and caregivers about its childhood immunization recommendations. States in the West Coast Health Alliance issued statements supporting the universal birth dose of the hepatitis B vaccine. These states include California, Hawaii, Oregon, and Washington. Many individual states also issued statements affirming the recommendation for the continued use of the hepatitis B vaccine birth dose, including Arizona, Colorado, Illinois, Michigan, New Mexico, and Vermont. States Issuing Standing Orders and Executive Directives At least two states issued a standing order or executive directive related to the hepatitis B vaccine: The Maryland Department of Health issued a standing order to ensure hepatitis B vaccine access for infants and children in the state. The standing order authorizes qualified health care providers to administer the hepatitis B vaccine and outlines the policies and procedures for administering the vaccine. In New Jersey, the acting health commissioner issued an executive directive recommending the hepatitis B vaccine birth dose and full series. States Issuing Public Health Alerts and Advisories Well before the recent ACIP meeting, the Maine CDC issued a health advisory to providers recommending the hepatitis B vaccine birth dose and full series. Since the ACIP meeting, at least two other states have released provider advisories. Maryland issued a letter to providers laying out the state’s hepatitis B vaccine recommendations, and New Hampshire issued a health alert with a continued recommendation for the full hepatitis B vaccine series and birth dose. In addition, Vermont sent a guidance letter to the providers in the state’s vaccine program. States Reexamine State Statutes and Agency Rules Linking to ACIP Recommendations Over the last several months, many states have proposed and enacted legislation to move away from sole reliance on ACIP recommendations. More recently, Massachusetts adopted H 4761, authorizing the health commissioner — in consultation with a newly established committee on immunization recommendations — to review and issue alternative standards to ACIP recommendations. States are also proposing changes to agency rules related to school and childcare immunization requirements. For example, Colorado’s health department has issued a proposed rule to modify the state’s standards for school and childcare immunization requirements and to align its rules with recent changes to state statute. Additional Considerations for States If CDC adopts the proposed ACIP recommendations, states can consider the following actions. Hepatitis B Screening States should continue to work with health care providers to close gaps in hepatitis B screening and follow-up for infants of HBsAg-positive mothers. Data show the most common cause of perinatal infection occurs when a mother with hepatitis B gives birth and the infant does not receive follow-up postexposure prophylaxis. Insurance Coverage While public and private insurance, including the Vaccines for Children program, are still required to cover the hepatitis B vaccine, such as any birth doses given to infants of HBsAg-negative mothers under shared clinical decision-making, states can consider creating additional coverage requirements. Some states have passed policies on insurance coverage, and other states have proposed legislation related to other vaccine coverage. Implementation of Shared Clinical Decision-Making While health care providers and parents have the flexibility to determine their approach for infants of HBsAg-negative mothers (i.e., continuing to recommend/give a birth dose), ACIP recommendations that rely on shared clinical decision-making have increased provider questions on how to have and document these conversations. States can work with medical associations, provider boards, and health care partners to ensure clinicians understand how to apply shared clinical decision-making recommendations. This includes educating staff in birthing hospitals, community clinics, and pediatric practices on how to counsel parents and document informed discussions. Jurisdictions can also develop or adapt educational materials and decision aids that clearly outline benefits, risks, timing, and follow-up options to support both providers and parents. More information on shared clinical decision-making is available from CDC and Common Health Coalition. States can also encourage providers and birthing institutions to examine workflows, Immunization Information System documentation, and follow-up to ensure scheduling of future doses. Implications for Vaccine Supply States can examine vaccine supply through the Vaccines for Children program to understand how the new recommendations impact supply of single antigen hepatitis B vaccines. If a significant percentage of the population receives vaccines on a different timetable, it could impact supply and timing for other vaccinations, given the reliance on combination vaccines for hepatitis B dose two and three, which can include DTaP, polio, and Hib vaccines. Supplemental Resources Common Health Coalition: Vaccine Resources December 2025 ACIP Meeting: Hepatitis B Updates for Health Leaders (PDF) Vaccine Integrity Project – Hepatitis B by Centers for Infectious Disease Research and Policy Understanding the Benefits of Vaccines: Common Questions by HealthyChildren.org Childhood Vaccinations (PDF) by Your Local Epidemiologist Hep B Birth Dose Media Toolkit by Hepatitis B Foundation Reframing the Conversation About Child and Adolescent Vaccinations by Frameworks Institute CDC: ACIP Shared Clinical Decision-Making Recommendations ACIP Meeting Materials for Public Posting: Hepatitis B Birth Dose Briefing Document (PDF) Hepatitis B Birth Dose Vaccination (PDF) article yes

Highlights evidence-based approaches that S/THAs can adopt to improve adult vaccination and strengthen data management.